What is capsular contracture?

by Hamawy, Adam

Breast implant surgery has come a long way, and implant manufacturers and surgeons have both made many improvements. Scores of women have had implants without incidence and are thrilled with them. But like any plastic surgery, there are risks. For breast implant surgery, the risk you’ll hear the most about is capsular contracture.

Unidentified Foreign Object

Capsular contracture is the most common problem associated with breast implant surgery. It’s basically a defense mechanism gone awry. Whenever a foreign object enters the body, such as a splinter, your body goes into defense mode. It needs to protect itself from foreign objects, so it tries to seal the foreign object off (quite brilliant, actually). To do this, it creates a “capsule.” The capsule is basically a layer of scar tissue around the object.

This same process happens when you get breast implant surgery, since implants (though safe) are foreign objects. But what can happen is that the scar tissue around the implant can start to squeeze the implant. It tightens — or contracts — which makes the breasts start to feel hard, causing discomfort and upward displacement of the implant (it moves up higher). When this happens, you have capsular contracture.

Causes, Risks, and Treatments

Many surgeons believe that capsular contracture is caused by a low-grade infection around the implant. We know that the risk is greater when the implants are placed behind the breast tissue and in front of the chest wall muscles. The theory is that the implant can get contaminated by the breast ducts, which normally contain some bacteria. However, if the surgeon places the implants behind the chest wall muscles and avoids cutting through the breast tissue, there is less incidence of capsular contractures. Irrigating the surgical area with antibiotics has also been shown to reduce the risk of capsular contracture.

In general, the rate of capsular contracture is higher for silicone implants than it is for saline ones. Saline implants placed under the muscle (either smooth or textured) show the least risk for capsular contracture. Studies have shown the risk is between 8 and 14 percent for saline implants. Capsular contracture is less common with the newer silicone implants, but the numbers are still higher. For smooth shell silicone implants, the rate is about 34 percent. For textured silicone breast implants, the rate is about 15 percent.

Treating capsular contracture can involve having a second surgery to remove the scar tissue (the capsule). Your surgeon may also recommend removing the implant itself and replacing it. Some surgeons recommend massaging the breast after surgery to help prevent the capsule from hardening. But there is no evidence to suggest that this prevents it (though it’s not harmful). If capsular contracture is top of your list of concerns about having breast implant surgery, talk with your doctor about whether or not saline implants are a good option for you, and if they can be placed under the muscle.